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PubMed2000

Unna and elastic postoperative dressings: comparison of their effects on function of adults with amputation and vascular disease.

OBJECTIVES: To compare the functional outcome associated with the use of Unna semirigid dressings (SRD) and elastic bandage soft dressings (ED) for adults with lower limb amputation. DESIGN: Experimental design. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: A successive series of adults with vascular disease who had lower limb amputation surgery. Subjects were randomly assigned to the SRD (12 patients with 12 recent amputations) or the ED (9 patients with 10 recent amputations) group. Subjects in each group were not significantly different except for age; those in the SRD group were somewhat older. INTERVENTION: Subjects in the SRD group had Unna dressings applied to the amputation limb by physical therapists trained in the technique. Those in the ED group had elastic bandaging by therapists, nurses, family, and themselves, all of whom were trained in the technique. RESULTS: Sixty-seven percent of the SRD group and 20% of those in the ED group were discharged from the rehabilitation unit ambulating with prostheses. Of those who received prostheses, time from admission to the rehabilitation unit to readiness for fitting averaged 20.8 days for the SRD group and 28.7 days for the ED group. Comparison of survival curves shows that the time from surgery to fitting in the SRD group was almost half that of the ED group; 30% of the SRD group was fitted within 34 days, whereas it took 64 days for the same percentage of the ED group to be fitted. CONCLUSIONS: Unna semirigid dressings are more effective in fostering amputation limb wound healing and preparing the amputation limb for prosthetic fitting. Subjects treated with SRDs were more likely to be fitted with prostheses and to return home walking with a prosthesis.

Aged↗

PubMed2002

[Venous stasis and deep vein thrombosis prophylaxis during laparoscopic fundoplication].

AIMS OF THE STUDY: first, to study the effect of a pneumoperitoneum (12 mm Hg) on femoral venous outflow, second, to evaluate the efficacy of mechanical antistasis devices: intermittent pneumatic compression (IPC), intermittent electric calf muscle stimulation (IECS) and graded compression leg bandages (LB) in reducing venous stasis, third, to determinate the incidence of deep venous thrombosis (DVT) after laparoscopic fundoplications using venous occlusion plethysmography method. PATIENTS AND METHODS: 54 patients undergoing elective laparoscopic fundoplications were studied. They were randomized into three groups - 18 patients in each group. The first group received LB, the second group received IECS and the third group IPC during operations. Lower extremity venous blood velocity was evaluated using Doppler ultrasonography during operation. In all 54 patients leg venous outflow was measured 1 day before and 1 day after operation using venous occlusion plethysmography method, in order to detect possible DVT after operation. The blood velocity in the femoral vein without pneumoperitoneum was 20.1 +/- 2.4 cm/s in the IPC group, 20.3 +/- 1.4 cm/s in the IECS group, and 23.9 +/- 1.2 cm/s in the LB group. With the introduction of a pneumoperitoneum (12 mm Hg) and the reverse Trendelenburg position the femoral venous blood velocity was significantly reduced in all groups: 9.3 +/- 0.9 cm/s in IPC group, 9.4 +/- 0.9 cm/s in IECS group, and 9.2 +/- 1.1 cm/s in LB group (p < 0.05). The maximum blood velocity generated by the IPC when a pneumoperitoneum (12 mm Hg) was present was 17.4 +/- 1.9 cm/s, and in the IECS group 14.0 +/- 1.1 cm/s, whereas in the LB group the blood velocity remained the same (9.2 +/- 1.1 cm/s). Calf DVT and pulmonary artery microembolization developed in one patient of the LB group, detected by venous occlusion plethysmography and lung perfusion scintigraphy methods one day after operation. CONCLUSIONS: The femoral vein stasis which appears in laparoscopic fundoplications can be minimized by reducing the intraabdominal pressure during operation, and avoiding reverse Trendelenburg position as much as possible. IPC is more effective than IECS in reducing venous stasis induced by the pneumoperitoneum and the reverse Trendelenburg position. Graded compression by leg bandages is ineffective in patients undergoing laparoscopic gastrofundoplication. With a pneumoperitoneum in place, neither device was able to return the depressed blood flow velocity to the values recorded without a pneumoperitoneum. The incidence of DVT and pulmonary embolism after laparoscopic fundoplications was 1.8 % in our study.

Adult↗

PubMed2006

[Bottoming out in augmentation mammaplasty--correction and prevention].

Displacement of a breast implant beneath the original submammary fold is known as a rare but, in most cases, difficult to correct complication after augmentation mammaplasty. Suggestions for re-centering the mammary implant range from simple percutaneous sutures to the additional application of expensive alloplastic dermal grafts. Based on the latest findings concerning plastination histology of the fascial system of the breast and in the light of our own clinical experience regarding correction of implant ptosis we have developed a special treatment concept. When placing the implant, the vertical fibers of the submammary fold are saved as a precautionary measure. In cases where there is a risk of possible inferior displacement of the mammary implant, an individually manufactured belt-like bandage is applied for approximately eight weeks postoperatively. In cases requiring the correction of a severe "bottoming out" deformity, we either lift the capsular shell of the implant or, if the fibrous capsule is thin and vulnerable, we use a special capsular flap technique resulting in a hammock that catches the implant at the height of the new submammary fold. Postoperative application of our belt-like bandage is again indispensable.

Bandages↗

PubMed2006

[The use of sonography in muscular injuries of the lower leg].

BACKGROUND: Over one third of all sports related injuries affect the muscle-tendon apparatus. Therefore an easy, quick and cost effective method for diagnosis and follow up is necessary. METHODS: We studied 50 patients with muscle strain injuries divided in two groups. The patients of group A received an elastic bandage, within the next 24 hours the first sonography of the affected limb was performed. The next check up was after 7 to 14 days and after 4 to 6 weeks. The average duration of use was registered. The visual analogue scale (VAS) was used to register pain, and the reduction of activity and motion was classified in three grades. In the patients of group B a tape bandage was applied to the injured leg. The same schedule was used for these patients. In all patients a cooling therapy was started as soon as possible. The two groups of patients were checked regularly using ultrasonography and compared to each other due to the different parameter. RESULTS: In 36 patients a muscular injury was detected sonographically during the first check up. In 13 patients on day 7 to 14, still a lesion was detectable. And in one patient 6 weeks after injury a lesion was still detectable. The 37 patients of group A reported an average of 6.9 points on VAS on day one, after 7 to 14 days 3.3 points and 0.8 points after the last check up. The 13 patients of group B reported an average of 6.7 points on VAS on day one, after 7 to 14 days 3.8 points and 2.0 points after the last check up. CONCLUSIONS: The clinical symptoms show good correlation to the sonographic results.

Adult↗

PubMed1994

[The effect of proprioception on functional stability of the upper ankle joint with special reference to stabilizing aids].

Both ankle joints of 14 uninjured volunteers and 16 patients with unstable ankle joints were tested regarding their proprioceptive capabilities. Three tests were used for the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace, stirrup-brace, taping) on the proprioceptivity of stable and unstable ankle joints were evaluated as well. The scores of the single-leg jumping course test without any stabilizing device (category "standard") ranged between 8.06 and 13.68 (10.65 +/- 1.29). In the categories "mikros" (9.85 +/- 0.99), "aircast" (9.99 +/- 1.14) and with the tape bandage (category "taping") (10.27 +/- 0.81) the scores were lower. In general, the scores of all trials with orthoses were lower compared to the category "standard". The differences of the categories "standard-mikros" and "standard-aircast" revealed a significant reduction of the scores when applicating these orthoses (p < 0.01). The differences of the category "standard-taping" as well as the single scores between the categories "mikros" and "aircast" were not statistically significant. According to the results of the single-leg stance test the error rate was within the range of 0-16 (5.12 +/- 2.85) for the category "standard", it was lower for the categories "mikros" (3.65 +/- 2.65) and "aircast" (4.17 +/- 2.59). The error rate was highest in the group with applicated tape bandage (5.79 +/- 3.53). The differences between the categories "standard"-"mikros" as well as "standard"-"aircast" were statistically significant (p < 0.01). There was also a significant difference between these categories regarding injured and uninjured ankle joints (p < 0.01). The pair differences of the categories "standard" and "taping" were below the significance level as well as the error rates of the categories "mikros" and "aircast". The ankle-reproduction-test showed higher values for the category "standard" (2.36 degrees +/- 0.97) in comparison to the categories "mikros" (1.46 degrees +/- 0.72). "aircast" (1.62 degrees +/- 0.91) and "taping" (1.84 degrees +/- 0.41). In the category "standard" the reproduction error of the uninjured ankle joints was lower (2.30 degrees +/- 1.04) compared to the group of unstable ankle joints (2.44 degrees +/- 0.81), whereas in all other categories the reproduction error was higher in the group of uninjured joints. The differences in all findings between the categories "standard"-"mikros" and "standard"-"aircast" were statistically significant (p < 0.01). The results of the three tests showed a statistically highly significant difference between injured and uninjured ankle joints (p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Ankle Injuries↗

PubMed1990

Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs.

Twenty-four parturients undergoing elective Caesarean section were allocated randomly to have the legs wrapped with elasticated Esmarch bandages immediately following spinal anaesthesia or to serve as controls. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) was treated with i.v. ephedrine in 5-mg boluses. Leg wrapped patients had a significantly (P = 0.0033) lower incidence (16.7%) of hypotension than controls (83.3%). Only two patients in the leg wrapped group required ephedrine compared with 10 in the control group. Systolic arterial pressure was significantly (P less than 0.05) less in control subjects at 4, 5 and 6 min following spinal injection. No patient in the leg wrapped group became hypotensive following removal of the elasticated bandages.

Anesthesia, Obstetrical↗

PubMed1991

Low-power HeNe laser treatment of venous leg ulcers.

Clinical observations have suggested that low-energy lasers, mainly helium-neon (HeNe) lasers, might stimulate wound healing. A controlled study of the effects of low-power HeNe laser was performed in conjunction with a standard treatment for healing chronic venous leg ulcers on 46 patients divided randomly into two groups. All patients received standard treatment (paste-impregnated bandage and a self-adhesive elastic bandage) plus either HeNe laser (wave-length, 632.8 nm; beam power, 6 mW; continuous emission, energy density, 4 J/cm2) or placebo HeNe laser twice weekly for 12 weeks. The areas of healing were examined and compared percentage-wise after 2, 4, 6, 8, and 12 weeks. There were no significant differences in the proportion of healed ulcers or ulcer area in the HeNe group compared with the placebo group.

Adult↗

PubMed1992

Electrical nerve stimulation improves healing of diabetic ulcers.

A controlled study of the effects of electrical nerve stimulation (ENS) was performed in conjunction with a standard treatment for healing chronic diabetic ulcers on 64 patients divided randomly into two groups. All patients received standard treatment (paste-impregnated bandage and a self-adhesive elastic bandage) plus placebo ENS or ENS (alternating constant current; frequency, 80 Hz; pulse width, 1 msec; intensity-evoking strong paresthesias) for 20 minutes twice daily for 12 weeks. Comparison of percentages of healed ulcer area and the number of healed ulcers was made after 2, 4, 6, 8, and 12 weeks. There were significant differences (p < 0.05) in both ulcer area and healed ulcers in the ENS group compared with the placebo group after 12 weeks of treatment. The results of the present study support the use of ENS in diabetic ulcers. ENS is easy to apply and can be used by the patient at home following instructions from a medical doctor or a therapist experienced in electrical stimulation and the treatment of ulcers. Additional studies are needed to identify the mechanisms involved in the promotion of ulcer healing with electrical stimulation and to determine the stimulus variables that most efficaciously accelerate tissue repair.

Aged↗

PubMedDate not supplied

Guidelines in practice: the effect on healing of venous ulcers.

OBJECTIVE: To determine the effect of guidelines on vascular assessment, compression usage, dressing selection, and healing rates of patients with a venous ulcer. DESIGN: Prospective descriptive intervention evaluation. SETTING: Oxfordshire Community National Health Service (NHS) Trust, United Kingdom. PATIENTS: 40 consecutive prospective patients seen by Oxfordshire district nurses, either at home or at a wound clinic coordinated by district nurses located in a surgery office. INTERVENTION: The Guideline for Diagnosis and Treatment of Venous Leg Ulcers (University of Pennsylvania) and the Oxfordshire Leg Ulcer Guideline. MAIN OUTCOME MEASURES: Time to healing, compliance with vascular assessment, compression usage, and nursing costs. MAIN RESULTS: 91% of patients had a vascular assessment; all patients were treated with compression. Mean time to healing was 8 weeks and was not related to dressing selection or type of compression (short- versus long-stretch bandage). Nursing costs were slightly higher for wounds that healed after 12 weeks and were treated with a long-stretch bandage (Pound Sterling 170.00 [$250.00] vs Pound Sterling 272.00 [$395.00]). CONCLUSION: Use of compression was influenced by guidelines that emphasize a vascular assessment. Choice of dressing or type of compression was not a significant factor in healing rates.

Aged↗

PubMed2006

Spontaneous wound dehiscence after removal of single continuous penetrating keratoplasty suture: conservative management.

PURPOSE: To describe a case of spontaneous wound dehiscence (WD) following removal of single continuous penetrating keratoplasty (PKP) suture, who was treated conservatively with a bandage contact lens. METHODS: A 36 year-old man who had penetrating keratoplasty for keratoconus 15 months earlier and removal of the single continues suture the previous week underwent ocular examination. He was treated with topical dexamethasone 0.3%, chloramphenicol 0.5% and cyclopentolate 1% 3 times a day and had a bandage contact lens (BCL) inserted. RESULTS: On presentation, he was complaining of reduced vision, tearing and pain following an attack of rhinitis-induced sneezing. His visual acuity (VA) in the affected eye was counting fingers, the anterior chamber was formed, the intraocular pressure (IOP) was low and there was a 2-clock-hour WD with a positive Seidel test but no iris incarceration. Two months later, his corrected VA was 6/5, his IOP was normal and the graft-host junction was good with no uplift. CONCLUSIONS: A 2-clock-hour WD after single continuous PKP suture removal may be conservatively treated with a BCL.

Adult↗

PubMed1985

Differential conduction of cold through barriers.

Despite the widespread use of ice packs in conjunction with ace bandages, padded ace bandages and compression dressings in the management of acute soft tissue trauma and sprains, the role of these barriers in the conduction of cold has not been adequately evaluated. Thermal probes were secured to both ankles of 62 healthy volunteers. The selected barrier was applied bilaterally and 500 g of chipped ice in a plastic bag was placed over the barrier on the right ankle for 30-45 minutes. A significant reduction in temperature of the right ankle was noted in all groups except in the padded ace group. The most rapid decrease in temperature was noted during the first 2 minutes of treatment. During the first minute, the surface temperature decreased an average of 22 degrees C (ace), 3.8 degrees C (dry washcloth), 5.2 degrees C (no barrier) and 5.4 degrees C (damp washcloth). After 10 minutes, the mean rate of cooling was 0.1-0.2 degree C and was approximately the same in all four groups. The Scheffe procedure indicated three homogeneous subgroups at 30 minutes: no barrier, damp washcloth; ace, dry washcloth; and padded ace. These findings question the clinical usefulness of the application of cold over padded aces and compression dressings and the use of a damp washcloth to 'protect' the skin from frostbite.

Bandages↗

PubMed1996

Early functional treatment for acute ligament injuries of the ankle joint.

Eighty-six patients with acute (< 24 h) grade II or III lateral ligament ruptures were randomized into two different non-surgical treatment groups. The main difference in treatment protocols between the two groups was during the first week after injury. Group I (n = 46) was to receive functional treatment using specially designed compression pads, elevation of the injured foot (24 h), repeated elastic wrapping (compression bandage followed by ankle tape), early full weight-bearing and proprioceptive range-of-motion training. Group II (n = 40) was to receive conventional treatment with an elastic bandage, partial weight bearing and crutches until the pain subsided. One week after the injury, patients from both groups were given identical rehabilitation instructions. No early surgery was performed. The mean follow-up period was 18 months. The functional results were satisfactory in 91% of the patients in group I and in 87% of the patients in group II (NS). Five patients had been operated on due to recurrent instability, two in group I and three in group II (NS). The mean sick leave was significantly shorter in group I; 5.6 +/- 4.2 days compared with 10.2 +/- 6.8 days in group II. Return to sports activities was also significantly earlier in group I, 9.6 +/- 4.8 days compared with 19.2 +/- 9.5 days in group II. In this study, non-surgical treatment of acute grade II and III ligament injuries of the ankle produced satisfactory results in the majority of patients. Early functional treatment resulted in shorter sick leave and facilitated an earlier return to sports, but it did not influence the final results.

Absenteeism↗

PubMed1997

Immediate external compression in the management of an acute muscle injury.

In a prospective, non-randomized study 40 athletes with contusion or distension injuries to the thigh or the calf muscle were followed with tests of range of motion (ROM) of knee or ankle joint, test of serum creatine kinase (CK) and ultrasonography of the injury until completely recovered. An experimental group of 19 injuries where subjects received treatment with application of a maximum compression bandage within 5 min (mean = 2 min) of the injury was compared to a control group of 21 injuries where subjects were treated with rest and elevation only, and in some cases non-maximum compression after 10-30 min. No significant differences were noted with respect to time to complete subjective recovery, ultrasonic size of the injury or time to normal findings on ultrasound between treatment and control groups. Strain injuries, although showing a tendency to be smaller in size, took a longer time to complete recovery than contusion injuries (mean +/- SD = 26 +/- 22 days and 19 +/- 9 days, respectively, P = 0.02). Diagnostic CK values and reductions in ROM were not correlated to the severity of the trauma, while ROM showed weak correlation to the sonographically measured size of the hematoma (r = 0.42: P < 0.01). Injuries displaying a circumscript anechoic, low-echogenic or mixed lesion at the diagnostic ultrasound investigation normalized more slowly (P = 0.001) and took longer to complete recovery (P = 0.001) than injuries with diffuse hyperechogenic lesions. We conclude that in this study the application of a maximum compression bandage within 5 min of a muscle trauma did not significantly reduce the size of the hematoma nor significantly shorten the time to complete subjective recovery compared with no immediate treatment. The diagnostic ultrasound investigation was valuable in predicting the severity of the trauma.

Adolescent↗

PubMed1981

Treatment of hygromata in horses.

A surgical technique of open drainage, using penrose drains and pressure bandages, was used for the treatment of hygromata in four horses. In 3 cases with hygroma of the carpus, one with a secondary infection, there was complete resolution of the condition whereas in the one case with hygroma of the elbow resolution was more protracted because of difficulties in bandaging. The cosmetic and functional results after operation were most satisfactory.

Animals↗

PubMed1979

Alternative postmeniscectomy regimen.

Eighty patients who had undergone routine meniscectomy were divided into two groups for postoperative management. The first 40 patients were treated by the traditional method of a compression bandage with a backsplint, followed by a 10-day stay in hospital. In the other 40 patients a compression bandage was applied, reinforced by a plaster cylinder. Weight-bearing was allowed with the aid of crutches, and patients were discharged after four days in hospital. Adequate splintage and early ambulation was more convenient and comfortable for postoperative management, and no complications ensued. Less time was needed for physiotherapy, and earlier return to work and resumption of normal activities were made easier.

Adult↗

PubMed1974

Vertical leg drainage of odema in treatment of leg ulcers.

Since oedema of adjacent tissue is a major factor in preventing healing of leg ulcers conservative treatment should aim to dry out the ulcer area before bandaging and to keep it dry afterwards. A method of postural drainage of oedema is described in which the patient lies supine with the legs raised vertically for two days. Non-stretch Viscopaste bandages are then applied and the patient allowed to move about normally, but instructed to continue vertical leg drainage for a period each day. Out of 106 cases treated by this method the leg ulcer healed within a year in 82 (77.4%). Relapses were apt to occur when the patient neglected to continue the vertical drainage regimen after the ulcer had healed. These results compare well with those reported for other methods of treatment. Vertical leg drainage treatment is inexpensive and the patient can continue at work.

Adult↗

PubMed1992

Community clinics for leg ulcers and impact on healing.

OBJECTIVE: To evaluate the effectiveness of community clinics for leg ulcers. DESIGN: All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle/brachial index > 0.8) were treated with a high compression bandage of four layers. SETTING: Six community clinics held in health centres in Riverside District Health Authority supported by the Charing Cross vascular surgical service. PATIENTS: All patients referred to the community services with leg ulceration, irrespective of cause and duration of ulceration. MAIN OUTCOME MEASURES: Time to complete healing by the life table method. RESULTS: 550 ulcerated legs were seen in 475 patients of mean (SD) age 73.8 (11.9) years. There were 477 venous ulcers of median size 4.2 cm2 (range 0.1-117 cm2), 128 being larger than 10 cm2. These ulcers had been present for a median of three months (range one week to 63 years) with 150 present for over one year. Four layer bandaging in the community clinics achieved complete healing in 318 (69%) venous ulcers by 12 weeks and 375 (83%) by 24 weeks. There were 56 patients with an ankle/brachial arterial pressure index < 0.8, indicating arterial disease. The 50 patients with pressure index < 0.8 > 0.5 were treated with reduced compression, and 24 (56%) healed by 12 weeks and 31 (75%) by 24 weeks. The figures for overall healing for all leg ulcers were 351/550 (67%) at 12 weeks and 417/550 (81%) at 24 weeks, compared with only 11/51 (22%) at 12 weeks before the community clinics were set up. CONCLUSIONS: Community clinics for venous ulcers offer an effective means of achieving healing in most patients with leg ulcers.

Aged↗

PubMed2001

A randomised controlled trial to determine the effectiveness of double Tubigrip in grade 1 and 2 (mild to moderate) ankle sprains.

OBJECTIVE: To compare functional outcome in patients with acute grade 1 or 2 (mild to moderate) lateral ankle sprains randomised to treatment with or without a double tubigrip bandage (DTG). METHODS: 400 patients presenting to the accident and emergency (A&E) departments of a teaching hospital and a district general hospital and diagnosed with grade 1 or 2 lateral ankle sprains were randomised to treatment with or without a DTG bandage. A standardised telephone questionnaire was performed one week after presentation. The main outcome measures were: number of days until walking unaided, number of days off work, whether the injury kept the patient awake at night, whether analgesia was taken. RESULTS: 197 of 400 patients completed follow up. There were no significant differences in terms of age, sex and occupation between the treatment groups. There were no significant differences between those who did and those who did not complete follow up. There was no significant difference between the treatment groups for number of days until walking unaided (95% CI -0.21 to 0.88 days), number of days off work (95% CI -0.70 to 1.02 days) or whether the injury kept the patient awake at night (95% CI -10 to 17%). There was a significant difference between the groups in the use of analgesia (95% CI 10 to 36%); the difference seemed to be that patients treated with DTG required significantly more analgesia. CONCLUSIONS: Treatment of grade 1 and 2 ankle sprins with DTG does not seem to lead to a shorter time to functional recovery and may increase the requirement for analgesia.

Adolescent↗